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Ball S G - - 1992
Angiotensin converting enzyme inhibitors are now widely used in the treatment of hypertension and heart failure. They are clearly as effective as other conventional antihypertensive agents in reducing blood pressure and combined with diuretics seem likely to transform current management of chronic heart failure. Myocardial infarction remains the major cause ...
Taylor S H - - 1992
During recent years, understanding of the basic pathology, pathophysiology, and morbid risk of ischemic heart disease has increased immensely, but a wide gulf still exists between such knowledge and its practical application to the individual patient. Although the treatment of ischemic heart disease continues to pose many dilemmas for the ...
Stevenson L W - - 1992
Over the past 25 years, the concept of circulation in heart failure has evolved from that of a simple circuit with a weak pump and high pressures to a complex integrated system of cellular modification, cardiac compensation and systemic neurohumoral responses. The original model of cardiac afterload as the systemic ...
Gueron M - - 1992
Scorpion envenomation is a common medical problem and life hazard in many countries of the world. Scientific investigations have addressed the interrelationship between the stimulatory effects of the venom on the autonomic nervous system and adrenals and the subsequent effects of released transmitters on the cardiovascular system. A number of ...
Coats A J - - 1992
The high prevalence and poor prognosis of heart failure are a major concern. Hospitalization for heart failure accounts for a major proportion of health-care expenditure. A number of large clinical trials have been initiated to assess therapeutic strategies to improve prognosis for patients with this condition. Results from one of ...
Young J B - - 1991
Heart failure has become a major worldwide public health problem. Several million patients suffer with this malady and large epidemiologic studies have documented mortality that can be in excess of 50% at 5 years. Furthermore, morbidity is great with this disease and hospitalizations are increasing yearly. Attention must be placed ...
Brunelli C - - 1991
Congestive heart failure is a syndrome with multiple causes and manifestations. While rheumatic heart disease and hypertension are in decline, coronary artery disease is the leading cause in patients referred for evaluation of heart failure. Decrease in cardiac contractility and general neurohormonal activation, which trigger alterations in mechanical and biochemical ...
Pepine C J - - 1991
L-carnitine has an important role in the metabolism of fatty acids. These molecules are carried to the mitochondrion after binding with L-carnitine. Fatty acids are oxidated in the mitochondrion only after binding with L-carnitine. Clinical experience suggests that this drug may have an important role in the treatment of several ...
Kleber F X - - 1991
Angiotensin-converting enzyme (ACE) inhibition slowed the progression of congestive heart failure (CHF) in 170 patients who were randomly assigned to either captopril or placebo in the Munich Mild Heart Failure Trial. The two major end points were progression from New York Heart Association (NYHA) functional classes I, II, or III ...
Gupta S C - - 1991
Congestive heart failure (CHF) is a common cause of morbidity and mortality in the elderly. Symptoms and signs of CHF in the elderly often differ from those in younger patients. Careful attention to these subtle differences helps in detection of concomitant illnesses that mimic or mask heart failure. The therapeutic ...
Smith T W - - 1991
The ideal therapeutic strategy would be to reverse the underlying cause of cardiac dysfunction, such as hypertension or valvular disease, while removing or minimizing those concurrent conditions or factors that tend to exacerbate symptoms. For most patients, vasodilator therapy has been shown to reduce mortality in moderate to advanced CHF.
Forman D E - - 1991
Digoxin is commonly used to treat congestive heart failure. Digoxin augments ventricular systolic performance, but does not benefit patients whose congestive heart failure is caused by poor diastolic function. We studied 47 elderly nursing home patients who were receiving long-term digoxin therapy. The left ventricular ejection fractions were measured using ...
Johnson J A - - 1991
The available literature on the evaluation of diastolic function, the importance of diastolic dysfunction in congestive heart failure (CHF), and the effects of therapeutic agents on diastolic dysfunction are summarized. The normal cardiac cycle consists of two components: systole (contraction; ventricular emptying) and diastole (dilation; ventricular filling). Recent studies have ...
Warren S E - - 1991
The clinical syndrome of congestive heart failure can result from inadequate myocardial contraction (systolic myocardial failure), from pseudo-heart failure due to circulatory overload, or from failure of the ventricles to fill at low pressure (diastolic myocardial failure). The presence of systolic or diastolic heart failure is most precisely defined by ...
Reicher-Reiss H - - 1991
The presence of calcium ions is essential to the normal function of the cardiovascular system. Drugs such as calcium antagonists can modulate the interaction between these ions and specific cells at different levels, interfering with myocardial contraction and relaxation, vascular tone, specific conduction tissues and neuromuscular function. Vascular beds play ...
Calvert C A - - 1991
Few studies have been conducted that focus on survival as the end point of medical therapy of CHF. No vigorous studies have been conducted in dogs. It is generally accepted that diuretic therapy is an essential component of the therapy of CHF in cardiomyopathic dogs. Significant symptomatic improvement is afforded ...
Pfeffer M A - - 1991
Progressive enlargement following myocardial infarction can be anticipated to adversely effect outcome since prognosis is intimately related to the degree of left ventricular dysfunction and resultant ventricular cavity size. Recent experimental and clinical data have indicated that chronic angiotensin converting enzyme inhibitor therapy can be effective in attenuating the ventricular ...
Knight D H - - 1991
The clinical literature on the subject of inotropic therapy of heart failure, particularly use of digitalis glycosides, is full of contradictions. Most of this disparity can be accounted for if not reconciled by taking the methodology of the clinical trials into consideration. Because drug interventions may produce subtle effects requiring ...
Fox P R - - 1991
Feline myocardial diseases today are largely represented by disorders involving LV hypertrophy. They may be attended by arrhythmias, congestive heart failure, systemic hypertension, thromboembolic complications, and sudden death. These structural myocardial disorders and their hemodynamic and electrocardiographic derangements may cause or result in variable degrees of diastolic dysfunction. Propranolol and ...
Mohan P - - 1991
We prospectively studied 69 consecutive patients hospitalized with a primary diagnosis of acute left ventricular failure so as to assess the impact of vasodilators on incidence and morbidity of acute symptomatic left ventricular failure. The determinants of duration of hospitalization, in-hospital mortality and symptomatic status 2 months after discharge were ...
Sasayama S - - 1991
A model of heart failure produced by rapid ventricular pacing in the conscious dog instrumented with a conductance catheter to monitor instantaneous left ventricular volume has been developed. This experimental model is capable of analysis of the left ventricular pressure-volume relationship on a beat-to-beat basis, and has been used to ...
Pouleur H - - 1991
The importance of the dopaminergic system in heart failure is unknown and the therapeutic potential of orally active compounds stimulating dopaminergic receptors has yet to be established. Despite similar acute haemodynamic changes in heart failure and despite a comparable profile of receptor stimulation, oral levodopa (the prodrug of dopamine) and ...
Cohn J N - - 1991
BACKGROUND: To define better the efficacy of vasodilator therapy in the treatment of chronic congestive heart failure, we compared the effects of hydralazine and isosorbide dinitrate with those of enalapril in 804 men receiving digoxin and diuretic therapy for heart failure. The patients were randomly assigned in a double-blind manner ...
- - 1991
BACKGROUND: Patients with congestive heart failure have a high mortality rate and are also hospitalized frequently. We studied the effect of an angiotensin-converting-enzyme inhibitor, enalapril, on mortality and hospitalization in patients with chronic heart failure and ejection fractions less than or equal to 0.35. METHODS: Patients receiving conventional treatment for ...
Judge K W - - 1991
The clinical characteristics and long-term survival of 284 patients from the Coronary Artery Surgery Study (CASS) registry data base who had moderate to severe congestive heart failure symptoms and a left ventricular ejection fraction greater than or equal to 0.45 were studied. A control group consisting of registry patients with ...
Moran J F - - 1991
Congestive heart failure is an increasingly common patient problem. It is a multisystem disease that involves not only the heart but also the kidneys and neurohormonal systems. Any treatment for heart failure should address depressed contractility and exercise intolerance, as well as control compensatory mechanisms. There are many different approaches ...
DiBianco R - - 1991
Phosphodiesterase inhibitors that are selective for cAMP-specific cardiac and vascular PDE III comprise a new group of agents for the treatment of heart failure, which at present are limited to clinical shortterm intravenous use and research uses only. Although both intravenous amrinone and milrinone are FDA approved, only amrinone is ...
Parmley W W - - 1991
Congestive heart failure is a common syndrome with high mortality in its advanced stages. Current therapy includes the use of vasodilator drugs, which have been shown to prolong life. Despite current therapy, mortality remains high in patients with severe heart failure. Potent new inotropic vasodilators have improved ventricular performance but ...
Ray S G - - 1991
There is activation of the renin angiotensin system after both complicated and uncomplicated myocardial infarction. Angiotensin II increases myocardial oxygen consumption whilst reducing coronary flow and is also directly toxic to the myocardium. Angiotensin converting enzyme inhibitors produce beneficial haemodynamic and neuroendocrine changes in patients with acute left ventricular failure, ...
Dzau V - - 1991
Advances in cardiovascular research during the past two decades have resulted in an improved understanding of the chain of events that lead to end-stage coronary artery disease. These developments have been paralleled by therapeutic advances that now make it possible to intervene at virtually every stage in the development of ...
Cohn J N - - 1991
Vasodilator therapy has become a major pharmacologic approach for improving left ventricular function, and consequently, vasodilator drugs are being used increasingly in the treatment of heart failure. Ideally, vasodilator drugs used in the long-term management of heart failure should show clearly defined pharmacodynamic effects. These include reduced impedance to left ...
Gaasch W H - - 1991
Diastolic dysfunction is a relatively common problem that may be mild and asymptomatic or may present with congestive heart failure and severe disabling symptoms. It is frequently due to coronary artery disease or left ventricular hypertrophy and it is especially common in the older population. The pathophysiology is related to ...
Schmitt B P - - 1991
Major changes in our understanding of congestive heart failure have resulted from an etiologic shift, identification of neurohormonal effects, and a realization of the importance of diastolic dysfunction. Accordingly, management has changed. Digitalis should be avoided with diastolic dysfunction. When the dysfunction is systolic, a regimen of digitalis, diuretic and ...
Krück F - - 1991
Diuretics, together with digitalis glycosides and vasodilators are of prime importance in the medical treatment of patients with congestive heart failure (CHF). Diuretics provide quick symptomatic relief in these patients. Their beneficial effect is related to the promotion of sodium and water excretion via the kidney, thus reducing extracellular fluid ...
Visser F C - - 1991
The recognition and management of heart failure is based on the knowledge of the underlying disease and precipitating factors. The underlying causes are all cardiovascular whereas precipitating factors comprise both cardiac and a variety of noncardiac factors. The influence of hypertension on the development of heart failure is complex. Increased ...
Francis G S - - 1991
Congestive heart failure has emerged as an important public health problem world wide. It is the single most common cause for hospitalization of patients over the age of 65 years in the United States. The past decade has witnessed the completion of a number of clinical trials which have been ...
Tan L B - - 1991
The assessment of cardiac function and dysfunction has often concentrated on particular but piecemeal aspects of ventricular performance. This leads to diverse and often opposite claims on how to define, evaluate and treat heart failure. This review adopts a more integrative approach of appraising the heart, putting it in the ...
Sharpe N - - 1991
The prognosis for clinical congestive heart failure remains poor even with modern treatment as severe ventricular dysfunction is often present at the time of clinical presentation. A substantial improvement in prognosis might be achieved through earlier intervention and a preventive approach to treatment following myocardial infarction to delay progressive ventricular ...
Birgersdotter-Green U - - 1991
The prognosis for patients with congestive heart failure (CHF) is poor, with a mortality exceeding 50% within 5 years from diagnosis. This poor prognosis remains despite improved pharmacological therapy. Because the prevalence of sudden death among these patients is high, reported to exceed 40%, the prognostic importance of ventricular tachyarrhythmias ...
Leibovitch E R - - 1991
Congestive heart failure (CHF), a disease seen primarily in the older patient, can be due to either systolic or diastolic dysfunction. Management is quite different if the heart failure is due to a filling abnormality as compared to poor ventricular systole. The disorder also poses many diagnostic pitfalls in the ...
Kannel W B - - 1990
The bulk of the mortality (60%) in hypertension occurs in those with mild to moderate elevations of blood pressure, and the chief hazard is coronary disease. Although progression in the severity of hypertension has been slowed with drug therapy, the benefits for coronary outcome and all-cause mortality have been equivocal. ...
Swan H J - - 1990
A review of the clinical course of chronic heart failure demonstrates that current outcomes remain highly unsatisfactory both in mortality and perhaps more important in morbidity. The extraordinary satisfactory functional responses seen in patients who undergo cardiac transplantation clearly identify the primary cause as the status of the heart itself, ...
Taylor S H - - 1990
Loss of myocardial contractility, reflexly enhanced vasoconstriction, and neuroendocrine excitation are the pathophysiologic hallmarks of low-output heart failure. Drugs that counter both consequences afford considerable therapeutic potential in retarding and perhaps even in staying the consequences of the syndrome. Ibopamine possesses such potential through its unique ability to stimulate both ...
Francis G S - - 1990
Neuroendocrine activation is known to occur in patients with congestive heart failure, but there is uncertainty as to whether this occurs before or after the presence of overt symptoms. In the Studies of Left Ventricular Dysfunction (SOLVD), a multicenter study of patients with ejection fractions of 35% or less, we ...
Cohn J N - - 1990
The four major diagnostic criteria for the syndrome of congestive heart failure are left ventricular dysfunction, exercise intolerance, pulmonary congestion or edema and ventricular arrhythmias. Activation of norepinephrine, angiotensin II, vasopressin and atrial natriuretic peptide may be a key factor in the vasoconstriction and increased impedance to left ventricular ejection ...
Hirsch A T - - 1990
The circulating renin-angiotensin system (RAS) plays an important role in the maintenance of cardiovascular homeostasis. It has recently been demonstrated that endogenous RAS exist in target tissues that are important in cardiovascular regulation. This article reviews the multiple effects of angiotensin II in target tissues, the evidence for the presence ...
Francis G S - - 1990
Congestive heart failure is a complex clinical syndrome that has its basis in an abnormality of myocardial cell function resulting in impaired ventricular performance, exercise intolerance, and ventricular arrhythmias. The functional defect in myocardial performance may be related to alterations in receptor function, in regulatory proteins, or in biochemical mechanisms. ...
Arai A E - - 1990
The syndrome of congestive heart failure can result from a variety of cardiac disorders of which left ventricular dysfunction is the most common. The clinical presentation is determined by the interaction between cardiac dysfunction and a series of compensatory mechanisms that are activated throughout the body. Therapy for this disorder ...
Deedwania P C - - 1990
Angiotensin-converting enzyme inhibitors have had a significant impact on the treatment of congestive heart failure (CHF). Hemodynamic and clinical improvements in patients with severe CHF fostered the use of angiotensin-converting enzyme inhibitors in mild to moderate CHF. Angiotensin-converting enzyme inhibitors produce acute and sustained improvements in ventricular hemodynamics and quality ...
Vine D L - - 1990
Causes of congestive heart failure include hypertension, coronary artery disease, alcohol abuse and valvular heart disease. Two-dimensional echocardiography with Doppler examination is excellent for identifying valvular heart disease. While noninvasive screening for coronary artery disease may seem cost-effective, the consequences of a missed diagnosis are such that coronary angiography should ...
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